Centers for Disease Control photoRelative sizes of several ticks at different life stages. In general, adult ticks are approximately the size of a sesame seed and nymphal ticks are approximately the size of a poppy seed. Purchase photo reprints »

Since he grew up in western Connecticut, spending lots of time enjoying the wooded outdoors, Robert Lingle was not worried after developing a rash, feeling flushed and running a fever a year or so after moving to Charlemont several years ago. But Lingle, whose knee also swelled so badly that he could not bend it and had to be rushed to the emergency room, tested negative for Lyme disease and then watched his elbow swell up about a week later.

Lingle, who had begunand then abandoned graduate studies in public health, started getting frustrated with how hard it was to get a diagnosis for what he suspected might be Lyme disease. And in his more than 2½ years of being treated for an array of symptoms, Lingle — who chairs the Franklin Regional Council of Government’s Cooperative Public Health Service Board — has become much more cautious every time he heads out to the woods.

The state Department of Public Health’s most recent surveillance data, for 2011, showed 52 confirmed Lyme disease cases in Franklin County in 2011 — an incidence rate of 73 per 100,000 people, higher than in 2010.

But Lingle, 52, says that given the trouble in diagnosing the disease, “I think it’s a bigger health crisis than people even know.”

And he adds, “I think prevention will be the biggest component in beating this thing. Many young people, believe that life is infinite, and respond with ‘So come on!’ ” when advised to take precautions. “But it can get you, too,” cautions Lingle.

With that in mind, the COG’s public-health cooperative is focusing on prevention and education, with help from a $1,500 state grant to place 100 warning signs at trail heads in its 10 member towns. There were 34 confirmed or suspected cases of Lyme disease in those towns between May 2012 and May 2013, nearly half of the total infectious disease cases reported by the regional health cooperative in that time.

The disease, carried by deer ticks that are prevalent in brushy, wooded and tall -grass areas, “is preventable, if people take the correct steps to avoid being bitten by ticks in the first place and know what to do if they are,” says the program’s public health nurse, Lisa White. “That’s where we’re focusing our energy.”

The warning signs and other informational materials advise people to use DEET insect repellent on hands, the nape of the neck and other exposed skin, to wear long pants with legs tucked in socks, and to do a thorough body check and showering soon after coming in from outdoors. It also recommends calling a physician if bitten by a tick.

White also encourages people to apply an insect repellent containing Permethrin to clothing worn regularly outdoors.

“These prevention steps, while they may be cumbersome and a different way of doing things, are sort of what circumstances call for at this point,” White says. ”This is a behavior change, and well worth the time and effort if it could prevent a case of illness. This is a serious public health issue.”

There are plenty of other hazards from ticks as well, including those carried by larger wood ticks. And for anyone with a dog or cat, there’s the danger of having those pets bringing ticks into the house — and into the bed or on the couch with you if you’re not cautious.

Lingle, who went on to develop symptoms that included an inflammation of the optic nerve, with double-vision fatigue and “brain fog,” and managed to get a prescription for the antibiotic doxycyline from an infectious disease specialist, even without a definitive diagnosis from a battery of tests. The antibiotic caused a “Jarisch-Herxheimer” reaction — with its own “horrible” symptoms Lingle describes like those of a bad flu, so he has to stop its use every four months or so, with a return of the double-vision, balance and cognitive problems and other Lyme symptoms.

“The symptoms are vague, some sound psychological, and they come and go and mimic a lot of other things — fibromyalgia, reflex sympathetic dystrophy, rheumatoid arthritis, MS, ALS ...,” says Lingle, adding that the suspicion of a growing number of health experts is that many of these symptoms point to Lyme and other tick-borne diseases, even without definitive test results.

Lingle, whose dog also contracted Lyme disease — as has his partner, and his visiting sister and cousin — has ramped up his own preventive steps, including hip boots and confining his outdoor adventures to staying on the trail, so he believes he’s had fewer reinfections.

Still, he compares living around a growing tick population to playing Russian roulette, especially given that the size of a deer tick is about the same as a poppy seed.

“A tick will most likely infect you when it’s in the nymph stage, and it looks like a tiny dust speck,” says Lingle. “I don’t know how anybody, in God’s name — especially an older person who’s got vision issues, could see that.”

As much as he remembers regularly walking through the woods barefoot and wearing shorts, he says he’s come around to believing what an ounce of prevention is worth in preventing Lyme disease.

“Err on the side of caution,” he says, “because it will change your life.”